Prise de décision concernant les grossesses non désirées chez les adolescents à Jamestown, Accra, Ghana.

Abstract

Adolescent pregnancies constitute a public health concern globally, especially in low and medium income countries. Most of these pregnancies are unintended, and could end up in unsafe abortions, often associated with high mortality and morbidity rates. Studies investigating the decision making process, the preferences, challenges and experiences of adolescents when faced with unintended pregnancies in Ghana rare. A systematic review to ascertain the prevalence and determinants of unintended pregnancy in Sub – Saharan Africa was carried out. This was followed by an empirical phase using qualitative (interviews and focus group discussions) and quantitative methods to ascertain adolescent and stakeholders experiences, perceptions, and attitudes towards adolescent abortions and childbirths. An ethical reflection through the lens of the principles of medical ethics proposed by Beauchamp and Childress and Immanuel Kant's aided in understanding the meaning of autonomy in adolescent pregnancy decision making. Adolescents simply have a false feeling of having taken the final decision themselves. Rendering decision making as autonomous as possible is important as trust is enhanced between the adolescents and health care providers, and they are therefore more likely to take informed decisions and adhere to the advice and recommendations of the health care providers. We propose a concept of relational autonomy that integrates the social reality in this community of embracing early adolescent pregnancies. This is grounded on the fact that a good number of adolescent pregnancies are intentional, and would require a different approach to dissuade adolescents and the community from desiring kids early in an adolescent's life course.